Rationale

Mortality is a basic indicator of health. Therefore, understanding its epidemiology is fundamental for effective public health planning and action.

Vital statistics are accessible for all European countries, but in most instances, these data are not readily available during crises or for imminent health threats. With the emergence of new diseases or threats of epidemics (e.g. pandemic influenza, SARS), decision makers will need such data to estimate the severity of the problem and inform any initiatives to be put in place as part of an effective public health response.

As many public health threats are not restricted by borders, international unified approaches are critical to detect and estimate the magnitude of excess deaths, as pooling of data increases power to detect changes quickly. Mortality monitoring should be ongoing to detect when and where excess mortality occurs.

Mortality monitoring becomes pivotal during influenza or other pandemics for several reasons. In a severe pandemic, mortality monitoring can be a robust way to monitor the pandemics progression and its public health impact when other systems are failing, due to an overburdened health care sector. Decision makers will require data on the pandemics impact and on deaths by age and geographical area in various stages of the pandemic. Mortality monitoring can provide such estimates, which will be important to guide and prioritize health service response and decision-making, i.e. use of antivirals and vaccines.

Mortality monitoring is also valuable for determining the impact of extreme environmental conditions on human life (heat waves, cold snaps) or of deliberate release of biological agents. Recent climatic events resulted in periods with excess mortality in many European countries and will affect Europe in the future. The timely assessment of the impact of such exposures is required to guide public health measures, e.g. help to vulnerable groups.

Mortality monitoring methodology is complex and there is a risk of countries sharing incompatible information if different methodologies are used. The lack of an agreed common methodology to assess mortality during a major health crisis affecting several European states limits use of this potentially very powerful information source. Thus, a timely mapping of the impact of health threats on mortality across different countries greatly benefit from a uniform approach.